9 spine surgeons discuss their favorite MIS technology


Here are nine spine surgeons on their favorite minimally invasive spine technology.

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Neel Anand, MD, professor of orthopedic surgery and director of spine trauma at Cedars-Sinai Spine Center in Los Angeles
Minimally invasive Oblique Lateral Interbody Fusion (OLIF). I believe it is the workhorse of minimally invasive surgical correction of scoliosis and it has made a complex surgery that much safer and effective for patients.

Ali Araghi, DO, director of spine at Phoenix-based The CORE Institute
XLIF with or without plating is my favorite technique, as it allows me to correct sagittal and coronal plane segmental spinal deformities and decompress the canal via indirect reduction, all through a small incision with minimal morbidity in well selected cases. I find this technique to be even more muscle sparing than an MIS decompression and TLIF with a larger foot print of interbody support.

Carlos Arias, MD, spine surgeon at Del Rio Hospital Universitario in Ecuador
My favorite is a minimally invasive retractor named Maxcess from Nuvasive because allow me to perform posterior and lateral approaches in cervical, thoracic and lumbar spine.

Vincent Arlet MD, chief of orthopedic spine surgery at Philadelphia-based University of Pennsylvania
Anterior Interbody fusion 5/1 or lateral antepsoas anterior interbody fusion.

Bobby Bhatti, MD, president and founder of Atlanta Spine
One thing we do a lot of and we do well is lateral. It's a powerful tool and restores sagittal balance, and I believe that's where things are heading at this point. There is also a lot of new technology coming out for it. We are in the design processes of a new lateral cage that expands and does a ventral column reconstruction at the same time without cutting or spreading the fibers. Because the retractors have improved we can use the retractors better.

Randolph Bishop MD, medical director of Neurological & Spine Institute in Savannah, Ga.
My favorite minimally invasive technology is the spinal endoscope. Using the visualization provided with the endoscope and tools deployed through the working channel, a surgeon can remove compressive lumbar disc pathology, open the neural foramina, perform facet rhizotomy, and/or fuse the spine with or without instrumentation. All this can be done with minimal anesthesia, minimal collateral tissue damage, and result in faster return to pre-morbid functional ability.

Egon DoppenBerg, MD, Erinn Zacharias, PhD, Good Samaritan Hospital, Downers Grove, Ill.
Spine navigation systems continue to innovate and facilitate MIS. One example is the placement of pedicle screws which aim to improve accuracy and reduce radiation exposure over traditional MIS freehand techniques. However, these navigation systems have not resulted in superior clinical outcomes, lacking evidence of reduced rates of neurological injury, vascular injury or reoperation. A demonstrated clinical advantage must be established and appropriate patient selection and procedural complexity should be considered before widespread adoption of navigation systems as a whole over freehand techniques.

Jeffrey A Goldstein, MD, Chief of Spine Service--Education and Director of Spine Fellowship NYU Langone Health
Robot assisted spine surgery helps bring MIS to the next level. Robotics allow us to complete MIS surgery with less radiation exposure to the surgeon, patient and OR team. In addition, robots facilitate spine surgery with less soft tissue disruption and potentially improved precision, accuracy and patient outcomes. I look forward to seeing how robots can improve our ability to safely perform more difficult revisions or deformity procedures.

Richard Kube, MD, founder of Prairie Spine in Peoria, Ill.
My practice is mostly minimally invasive so there are a variety of things that I use. One of the more recent technologies is DTRAX®. We see a lot of patients with nonunions and this device allows us to do the procedures almost percutaneously, and we have seen success with getting these procedures to fuse. Patients experience less blood loss and shorter recovery times while surgeons do not have any tissue stripping and are able to perform the surgeries in an outpatient setting.

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